PRESQUE ISLE, Maine — Providers at The Aroostook Medical Center in Presque Isle began work in 2013 to raise awareness and reduce the use of antibiotics for patients with acute sinusitis, also known as a sinus infection. These efforts have come a long way in the past four years, and TAMC’s journey with this initiative was recently featured in a national newsletter by the American Board of Internal Medicine (ABIM).
Under “Choosing Wisely,” an initiative of the ABIM Foundation, TAMC took a two-pronged approach to making a change in the prevalent issue of over-prescribing antibiotics, focusing specifically on sinusitis. First was clinical intervention, ensuring TAMC providers prescribed antibiotics following proper criteria, particularly regarding mild to moderate sinusitis. At the same time, a great deal of effort went into patient education and changing expectations regarding antibiotic prescriptions.
According to TAMC officials, most sinus infections are viral and do not respond to antibiotics. Sinus infections are rarely caused by bacteria, with other causes of sinus infection including, but not limited to, pollutants, fungal infections, and allergies. However, many patients suffering from sinusitis seek relief from their medical providers and anticipate a prescription of antibiotics to alleviate symptoms.
The over-prescribing of antibiotics is not only a waste of money for patients, but it causes a public health threat by leading to the development of bacteria that are resistant to those antibiotics.
So where did this journey take TAMC?
“From a modest performance in the beginning, with providers following the prescribing recommendations only 11 percent of the time, we improved steadily,” said Dr. Jay Reynolds, TAMC’s chief medical officer.
Work began to change both providers’ practices and patients’ expectations. Staf reviewed monthly progress reports and shared best practices, tips and patient engagement tools.
The project began in TAMC’s primary care practices and later expanded to the emergency department and walk-in clinic. With new processes and interventions in place, performance eventually took off, according to Cherri Fitzpatrick, chief quality officer at TAMC.
“We are moving steadily toward a strong culture of transparency, performance improvement and evidence-based medicine,” she said.
Under this effort, compliance with Choosing Wisely recommendation rose steadily to regularly exceed 80 percent and ultimately reached a high of 100 percent in January 2017.
Based on the success of the antibiotics project, TAMC is now in the final stages of planning for a new initiative to reduce imaging for low-back pain. Providers in primary care, the emergency room and walk-in are also starting to use Choosing Wisely information for patient education regarding the prescribing of opioids.
“Opioids are common pain medicines which can help with short-term pain but are not the best way to treat chronic pain,” said Reynolds. “Opioids can be very addictive. There are other pain treatments that may work better and have fewer risks. Just as we changed our prescribing practices and patient expectations for antibiotics for sinusitis, we now need to do that with the prescribing of opioid pain medicines.”
